Managing Osteopenia or Osteoporosis

This information explains what osteopenia and osteoporosis are and how to manage them.

Bone mineral density is a measure of how dense your bones are. Osteopenia is a condition in which your bone mineral density is lower than normal. Having osteopenia can lead to osteoporosis. Osteoporosis is a disease in which your bones become weak and more likely to fracture (break).

Osteoporosis is often called a silent disease because there are usually no symptoms unless you have a fracture. The fractures usually occur in the spine, hip, ribs, and wrist. They can occur from doing normal, everyday activities.

Causes of Osteopenia and Osteoporosis

Your body is constantly making new bone and shedding (getting rid of) old bone. Osteoporosis develops when the amount of bone that your body makes is less than the amount of bone that it sheds.

Lifestyle factors that can increase the risk of osteoporosis for both men and women include:

  • Lack of exercise
  • Eating a diet low in nutrients, especially calcium and vitamin D
  • Drinking too much alcohol (more than 2 drinks per day for women or 3 drinks per day for men)
  • Consuming too much caffeine (more than 3 cups of coffee a day)
  • Smoking

Other things that can lead to bone loss include:

  • Bone marrow or connective tissue disorders.
  • Diseases that affect levels of hormones, such as estrogen and testosterone.
  • Thyroid disorders.
  • Certain medications, such as corticosteroids, heparin, some anticonvulsants, and methotrexate.
  • Hormonal therapy for prostate and breast cancers.
  • Going through menopause or taking medications like leuprolide (Lupron®) or goserelin (Zoladex®) that stop your ovaries from producing estrogen.
  • Radiation therapy.
  • Being on long-term bed rest and not being active.
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Diagnosing Osteopenia or Osteoporosis

If your doctor believes that you’re at risk for osteopenia or osteoporosis, they will recommend that you have a bone density test. This test measures bone density in your wrist, spine, and hip. It’s a painless test that is similar to an x-ray, but uses much less radiation.

Another test that your doctor may recommend is the NTX blood or urine test. This test measures how much of your bone has been lost. This gives your doctor information about how your bones are now and can help you and your doctor make treatment decisions.

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Managing Osteopenia or Osteoporosis

There are things you can do to decrease the chance that osteopenia will progress to osteoporosis, as well as reduce your risk for fractures.

Lifestyle changes

You can make changes in your lifestyle in order to reduce your risk of osteoporosis and its effects.


  • Don’t smoke or use tobacco products. If you need help quitting, contact the Memorial Sloan Kettering (MSK) Tobacco Treatment Program at 212-610-0507.
  • Limit your intake of alcohol to no more than 2 drinks a day if you’re a woman and 3 drinks a day if you’re a man.
  • Exercise
    • Your doctor may recommend exercises to strengthen your bones and muscles. These may be weight-bearing exercises that help increase bone density, such as walking, jogging, or running. They may also be non-weight-bearing exercises such as swimming.
    • Always talk with your doctor before starting a new exercise routine. If you have trouble establishing an exercise routine, talk with your doctor about whether physical therapy (PT) is right for you.
  • Eat a diet rich in calcium and vitamin D.
    • Make sure that you’re getting enough calcium. Most adults need 1,000 to 1,200 milligrams of calcium every day, but your doctor or dietitian can tell you how much calcium is right for you. The best way to get calcium is through food (see the table “Foods Rich in Calcium”).
      • If you don’t get enough calcium from your diet, you may need to take a calcium supplement. Calcium supplements come in different forms, including calcium carbonate and calcium citrate.
    • You need vitamin D to absorb and use calcium. Most adults with osteopenia or osteoporosis need at least 800 international units (IU) of vitamin D daily, but how much vitamin D you need may be different. Your doctor or dietitian can tell you how much vitamin D is right for you. Although the main source of vitamin D is the sun, you can also get it from food (see the table “Foods Containing Vitamin D”).
      • If you’re not getting enough vitamin D, you may need to take a vitamin D supplement. You can buy vitamin D supplements at your pharmacy without a prescription.
      • If you have low levels of vitamin D, your doctor may recommend that you take prescription supplements with higher amounts of vitamin D. This can bring your levels up to normal.
  • Talk with your doctor about medications.
    • There are medications available to help prevent and treat osteoporosis. Your doctor will discuss your options with you and prescribe the one that best meets your needs. Your nurse will go over any specific instructions for taking your medication.
  • Prevent falls.
    • Make your home safe to prevent falls. Here are some things you can do:
      • Remove throw rugs or attach them to the floor.
      • Install safety rails on stairs and grab bars in your shower or tub.
      • Apply nonskid tape or decals to your shower or tub floor.
      • Make sure the rooms in your house or apartment are well lit.
      • Wear sturdy shoes.
      • Stand up slowly after sitting or lying down, so that your body can adjust to the new position.
      • Use a cane or walker to improve your balance.
      • When you bend over, bend at your knees, not at your waist.
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Foods Rich in Calcium

in portion
in portion
Dairy foods
Yogurt, plain, nonfat
1 cup
(8 ounces)
265 150
Cheddar cheese 1½ ounces 307 171
Gruyere cheese 1½ ounces 430 176
Parmesan cheese 1½ ounces 503 167
Milk, low-fat
1 cup
(8 ounces)
305 102
Milk, whole
1 cup
(8 ounces)
276 149
Non-dairy alternatives
Soy milk, plain, calcium-fortified
1 cup
(8 ounces)
301 80
Rice milk, plain, calcium-fortified
1 cup
(8 ounces)
283 113
Almond milk, vanilla, calcium-fortified
1 cup
(8 ounces)
451 91
Sardines, canned in oil, with bones, drained 2 sardines 92 50
Salmon, sockeye, canned, drained 4 ounces 263 189
Ocean perch, Atlantic, cooked 4 ounces 39 109
Mussels, steamed 4 ounces 37 195
Fruits and vegetables
Collards, cooked ½ cup 134 31
Turnip greens, cooked ½ cup 104 29
Kale, cooked ½ cup 47 18
Bok choy (Chinese cabbage), raw 1 cup 74 9
Brussels sprouts ½ cup 28 28
Figs, fresh 2 medium figs 35 74
Nuts, beans, and soy
Almonds ¼ cup 96 207
White beans, canned ½ cup 96 150
Edamame (soybeans), prepared ½ cup 49 95
Tofu, firm, prepared with calcium sulfate* ½ cup 253 88
Other foods and beverages
Fortified, ready-to-eat cereals (various)** ¾ cup to 1 cup 250-1,000 100-210
Orange juice, calcium fortified** 1 cup 500 117
Oatmeal, plain, instant, fortified** 1 packet prepared 98 101
Mineral water (e.g., San Pellegrino®, Perrier®)
1 cup
(8 ounces)
33 0
Basil, dried 1 teaspoon 31 3

*Calcium content is for tofu processed with a calcium salt. Tofu processed with other salts does not provide significant amounts of calcium.

**Check product labels, as amount of calcium varies.

Source: USDA National Nutrient Database for Standard Reference

Available at:

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Foods Containing Vitamin D

Vitamin D
in portion (IU)
in portion
Cod liver oil 1 tablespoon  1,360 123
Salmon, sockeye, canned, drained 4 ounces 953 189
Ocean perch, Atlantic, cooked 4 ounces 66 109
Tuna fish, light, canned in water, drained 4 ounces 53 97
Sardines, canned in oil, drained 2 sardines 46 50
Orange juice fortified with vitamin D*
1 cup
(8 ounces)
100 117
Milk, low-fat vitamin D fortified
1 cup
(8 ounces)
117 102
Egg, including yolk 1 large egg 44 78
Shitake mushrooms, dried 4 mushrooms 23 44
Chanterelle mushrooms, raw ½ cup 114 21

*Check product labels, as amount of added vitamin D varies.

Source: USDA National Nutrient Database for Standard Reference

Available at:

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